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Adult CPR/AED Training Request Form

(UW-Whitewater Use Only)

Name:
Department:
Office Phone:
E-mail:
  1. Please choose a course:
    Initial Course
    Refresher Course


  2. Comments:

If sending a hard copy is preferred, please print the form, complete the information, and send it via campus mail to:
Risk Management & Safety, Hyer Hall Room 330.

Once the form has been received, you will be added to a waiting list. When enough employees (minimum of 4) have expressed interest in taking a course, you will be contacted via email with further course information.